Advisory capacity only

May 8, 2008

As members of the clinical ethics service at Great Ormond Street Hospital for Children, we must challenge the picture painted in the article "Doing the right thing" (24 April).

You imply that complex ethical decisions are increasingly taken by "anonymous committees" rather than clinicians and parents. Clinical ethics committees provide advice, support and consultation, but our role is clearly defined as advisory. To remove the power to make decisions from the clinical team helping a child and their family would be wrong.

Provision of clinical ethics support requires appropriate skills, knowledge and personal attributes as specified by the UK Clinical Ethics Network, which the article does not mention.

The major emphasis of the article was on research rather than clinical ethics committees, but it is not always clear as to which type of committee those quoted are referring when they discuss training needs. Arguably the training requirements of members of research ethics committees can be met by short courses. We doubt that those who attend such short courses regard themselves as competent to make life-or-death decisions; neither would they be expected to do so.

Vic Larcher, Consultant in paediatrics and clinical ethics, Great Ormond Street Hospital for Children (GOSH)

Joe Brierley, Consultant in neonatal and paediatric intensive care,GOSH

Linda Franck, Professor of children's nursing studies, Institute of Child Health, London

Roisin Mulvaney, Administrator, Centre for Paediatric Ethics, GOSH.

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